Martha Stark MD – 16 Jun 2017 – The Transformative Power of Optimal Stress.pptx

THE TRANSFORMATIVE POWER
OF OPTIMAL STRESS
FROM CURSING THE DARKNESS
TO LIGHTING A CANDLE
NO PAIN / NO GAIN 
MARTHA STARK, MD
MarthaStarkMD @ HMS.Harvard.edu
SMITH COLLEGE SCHOOL FOR SOCIAL WORK
Friday, June 16, 2017
1

WHY IS IT THAT PEOPLE KEEP PLAYING OUT
ON THE STAGE OF THEIR LIVES
THE SAME SCENARIOS AGAIN AND AGAIN –
EVEN WHEN THEY KNOW THAT THE OUTCOME
WILL BE JUST AS DISAPPOINTING THIS NEXT TIME
AS IT WAS SO MANY TIMES BEFORE?
“INSANITY IS DOING
THE SAME THING
OVER AND OVER AGAIN
AND EXPECTING
DIFFERENT RESULTS”
(ALBERT EINSTEIN)
3

A SATURDAY NIGHT LIVE SKIT IN WHICH TWO
MEN ARE SEATED AROUND A FIRE CHATTING
AND ONE SAYS TO THE OTHER –
“YOU KNOW HOW WHEN YOU STICK
A POKER IN THE FIRE AND LEAVE IT IN
FOR A LONG TIME,
IT GETS REALLY, REALLY HOT?
AND THEN YOU STICK IT IN YOUR EYE,
AND IT REALLY, REALLY HURTS?
I HATE IT WHEN THAT HAPPENS!
I JUST HATE IT WHEN THAT HAPPENS!”
4

PEOPLE ARE TREMENDOUSLY INVESTED
IN THEIR COMPULSIVE REPETITIONS
AND THEIR RELENTLESS PURSUITS
SELF – PROTECTIVE BEHAVIORS THAT
PROTECT THEM AGAINST THE PAIN
OF ALL THE HEARTBREAK
THEY EXPERIENCED AS CHILDREN
PEOPLE HOLD ON TO THESE MALADAPTIVE DEFENSES,
WHICH HAVE LONG SINCE OUTLIVED THEIR
USEFULNESS BUT TO WHICH THEY NONETHELESS
CLING IN A MISGUIDED EFFORT TO AVOID
FEELING THE PAIN OF THEIR UNMASTERED GRIEF
5

FROM UNHEALTHY DEFENSE
TO HEALTHIER ADAPTATION
TRANSFORMING
THE NEED TO “DEFEND AGAINST”
INTO THE CAPACITY TO “ADAPT TO”
THE MYRIAD “STRESSORS OF LIFE”
(HANS SELYE 1974)
THE THERAPEUTIC USE OF “OPTIMAL STRESS”
TO FACILITATE THIS TRANSFORMATION
THE IMPORTANCE OF GRIEVING
ALBEIT BELATEDLY
ALL THE “STRESSORS OF CHILDHOOD”
THAT WERE NEVER FULLY GRIEVED
AT THE TIME AND “ADAPTED TO” BUT
WERE INSTEAD SIMPLY “DEFENDED AGAINST”
6

THE SELF – SABOTAGING
COMPULSIVE REPETITIONS AND
RELENTLESS PURSUITS TO WHICH
PEOPLE CLING TENACIOUSLY
REPRESENT THEIR BEST
EFFORT TO DEFEND THEMSELVES
AGAINST THE PAIN AND
TO KEEP THEIR HOPE ALIVE …
7

DEFENSES AND ADAPTATIONS
BOTH ARE SELF – PROTECTIVE MECHANISMS
MOBILIZED TO PRESERVE HOMEOSTATIC BALANCE
IN THE FACE OF ENVIRONMENTAL CHALLENGE
A YIN – YANG RELATIONSHIP
NONETHELESS
DEFENSES ARE GENERALLY LESS EVOLVED,
ADAPTATIONS MORE EVOLVED
DEFENSES ARE REFLEXIVE,
WHEREAS ADAPTATIONS ARE REFLECTIVE
WE NEED OUR DEFENSES TO SURVIVE
BUT OUR ADAPTATIONS TO THRIVE
8

THE OVERARCHING GOAL OF
ANY IN – DEPTH PSYCHOTHERAPY
INCREMENTAL TRANSFORMATION OF
LESS EVOLVED DEFENSE INTO
MORE EVOLVED ADAPTATION
THE NEED FOR IMMEDIATE GRATIFICATION
INTO THE CAPACITY TO TOLERATE DELAY
THE NEED FOR PERFECTION
INTO THE CAPACITY TO TOLERATE IMPERFECTION
THE NEED FOR EXTERNAL REGULATION OF THE SELF
INTO THE CAPACITY TO BE INTERNALLY SELF – REGULATING
THE NEED TO HOLD ON
INTO THE CAPACITY TO LET GO
9

THIS TRANSFORMATION OF NEED INTO CAPACITY
REQUIRES THE JUDICIOUS USE OF “OPTIMAL STRESS”
AGAINST A BACKDROP OF EMPATHIC ATTUNEMENT
AND AUTHENTIC ENGAGEMENT
SEVERAL “PROTOTYPE” STATEMENTS DESIGNED
TO PROVIDE JUST THE RIGHT COMBINATION OF
CHALLENGE
TO DESTABILIZE DEEPLY
ENTRENCHED MALADAPTIVE DEFENSES
AND SUPPORT
TO FACILITATE THEIR RESTABILIZATION
AT A HIGHER LEVEL OF ADAPTIVE CAPACITY
10

ONGOING USE OF THESE
OPTIMALLY STRESSFUL INTERVENTIONS
WILL GIVE RISE TO
RECURSIVE CYCLES OF DISRUPTION
IN REACTION TO THE ANXIETY – PROVOKING CHALLENGE
AND REPAIR
IN RESPONSE TO THE ANXIETY – ASSUAGING SUPPORT
HEALING CYCLES OF
DISRUPTION AND REPAIR
AT EVER – HIGHER LEVELS
OF AWARENESS, ACCEPTANCE,
ACCOUNTABILITY, AND ACCESSIBILITY
11

NO PAIN
NO STRESS OR STRAIN
NO GAIN
MY FIRM BELIEF IN THE UNDERLYING RESILIENCE
THAT PATIENTS WILL INEVITABLY DISCOVER
WITHIN THEMSELVES WHEN FORCED TO TAP INTO
THEIR INBORN ABILITY TO SELF – CORRECT
12

SUPERIMPOSING AN ACUTE
PHYSICAL INJURY
ON TOP OF A CHRONIC ONE
IS SOMETIMES
EXACTLY WHAT THE BODY
NEEDS IN ORDER TO HEAL
“CONTROLLED DAMAGE”
TO PROVOKE HEALING
13

MILD AGGRAVATIONS TO STIMULATE
THE HEALING CASCADE
IMMUNOTHERAPIES (VACCINATIONS)
HOMEOPATHIC REMEDIES
ACUPUNCTURE
PROLOTHERAPY
WOUND DEBRIDEMENT
DERMABRASION
FRAXEL LASER TREATMENTS
DEFIBRILLATION
CARDIOVERSION
ELECTROSHOCK THERAPY (ECT)
DEEP BRAIN STIMULATION (DBS)
14

MODERATE AMOUNTS OF STRESS
TO PROVOKE
MODEST OVERCOMPENSATION
HIGH – INTENSITY INTERVAL TRAINING (HIIT)
OPTIMAL CHALLENGE OF THE BRAIN
STRESSING THE MIND WITH BRAIN TEASERS
AND MENTAL EXERCISES REQUIRING
DELIBERATE AND CONCENTRATED EFFORT
IN ORDER TO SHARPEN MENTAL ACUITY,
DECELERATE COGNITIVE DECLINE,
AND COMBAT THE EFFECTS OF AGING
15

DEPRIVING YOURSELF OF HALF A NIGHT’S SLEEP
PREFERABLY THE SECOND HALF OF THE NIGHT
CAN PRODUCE A RAPID, EVEN IF TEMPORARY,
RESTABILIZATION OF MOOD
AND RECOVERY FROM DEPRESSION
(LEIBENLUFT AND WEHR 1992)
A 36 – HOUR WATER FAST ONCE A WEEK
CAN SO SIGNIFICANTLY REDUCE THE
TOTAL BODY BURDEN THAT MENTAL CLARITY
AND FOCUS CAN BE IMPROVED DRAMATICALLY
DUKE UNIVERSITY MEDICAL CENTER
DISCOVERED THAT IF YOU DO 40 MINUTES OF
AEROBIC EXERCISE DURING THE DAY,
THEN YOU WILL NEED 40 MINUTES LESS
OF SLEEP THAT NEXT NIGHT
(BLUMENTHAL et al. 1999)
16

THE THERAPEUTIC VALUE
OF CONTROLLED DAMAGE
WHETHER PHYSICAL, MENTAL, OR EMOTIONAL
AN APPROACH SPECIFICALLY GEARED
TOWARDS MOBILIZING THE BODY’S
INTRINSIC ABILITY TO RENEW ITSELF
IN THE FACE OF ENVIRONMENTAL IMPINGEMENT
WHETHER REAL OR IMAGINED
A CONDITION MIGHT NOT HEAL
UNTIL IT IS MADE ACUTE
17

THE THERAPEUTIC USE
OF OPTIMAL STRESS
TO PROVOKE RECOVERY
BY ACTIVATING
THE LIVING SYSTEM’S
INNATE ABILITY
TO HEAL ITSELF
STRONGER AT THE BROKEN PLACES
18

STRESS IS WHEN
YOU WAKE UP SCREAMING
AND THEN YOU REALIZE
YOU HAVEN’T FALLEN
ASLEEP YET
ANONYMOUS
19

STRESSFUL STUFF HAPPENS
BUT IT WILL BE HOW WELL WE ARE
ULTIMATELY ABLE TO MANAGE ITS IMPACT
THAT WILL MAKE ALL THE DIFFERENCE
IN OTHER WORDS
IT WILL BE HOW WELL WE ARE
ULTIMATELY ABLE TO COPE WITH THE
IMPACT OF STRESS IN OUR LIVES
THAT WILL EITHER
DERAIL OUR DEVELOPMENT
WHEN ALL WE KNOW HOW TO DO IS TO REACT DEFENSIVELY
OR TRIGGER OUR GROWTH
ONCE WE HAVE BECOME BETTER ABLE TO RESPOND ADAPTIVELY
TO THE MYRIAD DISAPPOINTMENTS, FRUSTRATIONS,
AND LOSSES WITH WHICH LIFE CONFRONTS US
21

PSYCHODYNAMIC PSYCHOTHERAPY
OFFERS THE PATIENT AN OPPORTUNITY
ALBEIT A BELATED ONE
TO MASTER STRESSFUL EXPERIENCES
THAT HAD ONCE BEEN OVERWHELMING
AND THEREFORE DEFENDED AGAINST
BUT THAT CAN NOW
WITH ENOUGH SUPPORT FROM THE THERAPIST
AND BY TAPPING INTO
THE PATIENT’S UNDERLYING RESILIENCE
AND CAPACITY TO SELF – CORRECT
BE PROCESSED, INTEGRATED,
AND ULTIMATELY ADAPTED TO
22

FROM DEFENSIVE REACTION
TO ADAPTIVE RESPONSE
FROM EXTERNALIZING BLAME
TO TAKING OWNERSHIP
FROM WHINING AND COMPLAINING
TO BECOMING PROACTIVE
FROM DISSOCIATING
TO BECOMING MORE PRESENT
FROM FEELING VICTIMIZED
TO BECOMING EMPOWERED
FROM DENIAL
TO CONFRONTING HEAD – ON
FROM CURSING THE DARKNESS
TO LIGHTING A CANDLE
23

COME TO THE EDGE
SPEAKS TO BOTH THE UNIVERSAL RESISTANCE
TO LETTING GO OF WHAT IS FAMILIAR
AND THE POTENTIAL CAPACITY (WITHIN ALL OF US)
NOT ONLY TO ADAPT TO, BUT ALSO TO
BENEFIT FROM, BEING OPTIMALLY CHALLENGED
COME TO THE EDGE.
WE MIGHT FALL.
COME TO THE EDGE.
IT’S TOO HIGH!
COME TO THE EDGE!
AND THEY CAME,
AND HE PUSHED,
AND THEY FLEW …
(CHRISTOPHER LOGUE 1968)
24

VIKTOR FRANKL (2006)
“BETWEEN STIMULUS AND RESPONSE
IS A SPACE.
IN THAT SPACE IS OUR POWER
TO CHOOSE OUR RESPONSE.
IN OUR RESPONSE LIES
OUR GROWTH AND OUR FREEDOM.”
… IN THAT SPACE LIES OUR POWER
TO CHOOSE WHETHER WE
REACT DEFENSIVELY OR RESPOND ADAPTIVELY
WHETHER WE CLING TO OUR
COMPULSIVE REPETITIONS AND RELENTLESS PURSUITS
IN ORDER TO AVOID THE PAIN OF OUR GRIEF
OR WHETHER WE DARE TO TAKE THE LEAP …
26

CHAOS THEORY
(STROGATZ 1994; KAUFMAN 1995)
IN ORDER BETTER TO UNDERSTAND
THE PATIENT’S RELUCTANCE TO
RELINQUISH HER MALADAPTIVE DEFENSES
THE PATIENT IS AN
“OPEN, SELF – ORGANIZING CHAOTIC SYSTEM”
CHAOTIC SYSTEMS
ALTHOUGH SEEMINGLY RANDOM
HAVE AN UNDERLYING ORDEREDNESS
THAT WILL EMERGE AS THE SYSTEM
EVOLVES AND “SELF – ORGANIZES”
27

NO MATTER HOW COMPROMISED THEY
MIGHT ULTIMATELY BECOME,
FUELED AS THEY ARE BY THEIR HOMEOSTATIC
TENDENCY TO REMAIN CONSTANT OVER TIME,
CHAOTIC SYSTEMS
ONCE “ORGANIZED”
ARE INHERENTLY RESISTANT TO CHANGE
THEY HAVE AN INERTIA
AND A ROBUST ORDEREDNESS
THAT MUST BE OVERCOME
IF THE SYSTEM IS EVER TO
“RE – ORGANIZE” ITSELF
28

“SELF – ORGANIZING SYSTEMS
RESIST PERTURBATION”
(CHARLES KREBS 2006)
PATIENTS MUST BE SUFFICIENTLY STRESSED
BY INPUT FROM THE OUTSIDE
THAT THERE WILL BE IMPETUS
FOR THE PATIENT’S MALADAPTIVE,
SELF – SABOTAGING DEFENSES
TO BECOME DESTABILIZED
AND THEREFORE OPPORTUNITY
FOR THE EMERGENCE OF MORE ADAPTIVE,
SELF – PROTECTIVE MECHANISMS
29

THE GOLDILOCKS PRINCIPLE
TOO MUCH CHALLENGE WILL BE TOO
OVERWHELMING FOR THE PATIENT
TO PROCESS AND INTEGRATE
TRAUMATIC STRESS
TOO LITTLE CHALLENGE WILL PROVIDE TOO
LITTLE IMPETUS FOR TRANSFORMATION
AND GROWTH BECAUSE THERE WILL
BE NOTHING THAT NEEDS TO BE MASTERED
30

THE GOLDILOCKS PRINCIPLE
BUT JUST THE RIGHT
AMOUNT OF CHALLENGE
JUST THE RIGHT AMOUNT OF STRESS
EUSTRESS (HANS SELYE 1974)
OPTIMAL STRESS
WILL OFFER JUST THE
RIGHT COMBINATION OF
CHALLENGE AND SUPPORT
NEEDED TO OPTIMIZE
THE POTENTIAL FOR
TRANSFORMATION AND GROWTH
31

IN AN EFFORT TO GET IT JUST RIGHT,
THE THERAPIST WILL KEEP HER FINGER ON
THE PULSE OF THE PATIENT’S ANXIETY
AND CAPACITY TO TOLERATE FURTHER STRESS
WHENEVER POSSIBLE
THE THERAPIST WILL CHALLENGE
THEREBY INCREASING THE PATIENT’S ANXIETY
WHENEVER NECESSARY
THE THERAPIST WILL SUPPORT
THEREBY DECREASING THE PATIENT’S ANXIETY
THEREBY TITRATING THE LEVEL OF STRESS
THAT THE PATIENT WILL EXPERIENCE
32

PARACELSUS (2004)
IN REFLECTING UPON THE STRESSFUL IMPACT
ON THE BODY OF AN EXTERNAL AGENT
THE DIFFERENCE BETWEEN
A POISON AND A MEDICATION
IS THE DOSAGE THEREOF
IT WILL ALSO BE THE SYSTEM’S
CAPACITY TO PROCESS, INTEGRATE,
AND ULTIMATELY ADAPT TO THE
IMPACT OF THE STRESSOR THAT WILL
ULTIMATELY MAKE THE DIFFERENCE
BETWEEN TRAUMATIC STRESS
AND OPTIMAL STRESS
33

SO A POISON IS NOT ALWAYS TOXIC
AND NOR IS A MEDICINE ALWAYS THERAPEUTIC
STRESS IS NOT ALWAYS BAD
OPTIMAL STRESS
AND NOR IS HOPE ALWAYS GOOD
RELENTLESS HOPE
(STARK 1994, 1999, 2014)
THE REFUSAL TO CONFRONT
– AND GRIEVE –
THE REALITY OF THE OBJECT’S
LIMITATIONS, SEPARATENESS,
AND IMMUTABILITY
34

THE SANDPILE MODEL AND
THE PARADOXICAL IMPACT OF STRESS
(BAK 1996)
TO DEMONSTRATE THE CUMULATIVE
IMPACT OVER TIME OF ENVIRONMENTAL
STRESSORS ON OPEN SYSTEMS
AN ELEGANT VISUAL METAPHOR FOR
HOW WE ARE CONTINUOUSLY REFASHIONING
OURSELVES AT EVER – HIGHER LEVELS OF
RESILIENCE AND ADAPTIVE CAPACITY
NOT JUST IN SPITE OF STRESSFUL INPUT
FROM THE OUTSIDE
BUT BY WAY OF THAT INPUT
(STARK 2012, 2014)
35

THE GRAINS OF SAND BEING STEADILY
ADDED TO A GRADUALLY EVOLVING
SANDPILE ARE THE OCCASION FOR
BOTH ITS DISRUPTION AND ITS REPAIR
NOT ONLY DO THE GRAINS OF SAND
BEING ADDED PRECIPITATE PARTIAL COLLAPSE
OF THE SANDPILE, BUT ALSO THEY BECOME
THE MEANS BY WHICH THE SANDPILE
IS THEN ABLE TO BUILD ITSELF BACK UP
EACH TIME AT A NEW LEVEL OF HOMEOSTASIS
THE SYSTEM WILL THEREFORE HAVE
BEEN ABLE NOT ONLY TO MANAGE
THE IMPACT OF THE STRESSFUL INPUT
BUT ALSO TO BENEFIT FROM THAT IMPACT
36

AND AS THE SANDPILE EVOLVES
AN UNDERLYING PATTERN
WILL BEGIN TO EMERGE
ITERATIVE CYCLES OF DISRUPTION AND REPAIR
DESTABILIZATION AND RESTABILIZATION
DEFENSIVE COLLAPSE AND ADAPTIVE RECONSTITUTION
AT EVER – HIGHER LEVELS OF
INTEGRATION AND DYNAMIC BALANCE
37

ALTERNATELY CHALLENGE AND THEN SUPPORT
TO PROVOKE HEALING CYCLES OF DISRUPTION AND REPAIR
JUST AS THE GRAINS OF SAND BEING
SYSTEMATICALLY ADDED
TO THE EVER – EVOLVING SANDPILE
ARE CONTINUOUSLY
“PRECIPITATING DISRUPTION IN ORDER TO TRIGGER REPAIR,”
SO TOO THE SYSTEMATIC USE OF
THERAPEUTIC INTERVENTIONS THAT
ALTERNATELY BREAK DOWN AND THEN BUILD UP
WILL PROVIDE BOTH IMPETUS AND OPPORTUNITY
FOR RESTRUCTURING THE PATIENT’S
DYSFUNCTIONAL DEFENSES
AT EVER – HIGHER LEVELS OF
RESILIENCE AND ADAPTIVE CAPACITY
38

CONFLICT STATEMENTS
DESIGNED TO HIGHLIGHT
THE INHERENT CONFLICT
THAT EXISTS WITHIN THE PATIENT
BETWEEN WHAT SHE “KNOWS”
IN HER HEAD
TO BE THE PRICE SHE PAYS
FOR CLINGING TO HER
COMPULSIVE REPETITIONS
AND RELENTLESS PURSUITS
AND WHAT SHE “FEELS”
IN HER HEART
WHEN CHALLENGED TO LET THEM GO
39

CONFLICT STATEMENT
“YOU KNOW THAT EVENTUALLY YOU WILL
NEED TO FACE THE REALITY THAT
YOUR MOTHER WILL NEVER BE ALL THAT
YOU WOULD HAVE WANTED HER TO BE
AND THAT YOU WILL NOT BE ABLE
TO MOVE ON IN YOUR LIFE UNTIL YOU
LET GO OF YOUR HOPE THAT SHE WILL;
BUT, IN THE MOMENT, YOU ARE TERRIFIED
THAT YOU WOULD NOT SURVIVE THE
HEARTBREAK AND DESPAIR YOU WOULD
FEEL WERE YOU FORCED TO CONFRONT
THAT DEVASTATING TRUTH.”
CHALLENGE TO INCREASE THE ANXIETY
SUPPORT TO DECREASE IT
40

CONFLICT STATEMENT
“YOU KNOW THAT IF YOU ARE EVER
TO BE ABLE TO MOVE FORWARD IN
YOUR LIFE THEN YOU WILL NEED TO
LET ANKA GO BECAUSE SHE REALLY
IS NOT AVAILABLE IN THE WAYS THAT
YOU WOULD HAVE WANTED HER TO BE;
BUT YOU KEEP HOPING THAT
MAYBE, JUST MAYBE,
SOMEDAY SHE WILL CHANGE.”
“PRETENDING THAT SOMETHING
CAN BE WHEN IT CAN’T IS HOW
PEOPLE BREAK THEIR HEARTS.”
(SEMRAD 1983)
41

CONFLICT STATEMENTS
WHEN THE THERAPIST INTRODUCES
THE STATEMENT WITH
“YOU KNOW THAT …,”
SHE IS ASKING THAT
THE PATIENT TAKE
RESPONSIBILITY FOR
WHAT THE PATIENT
ALBEIT BEGRUDGINGLY
REALLY DOES KNOW TO
BE THE PAINFUL TRUTH
42

CONFLICT STATEMENTS
BY LOCATING “WITHIN” THE PATIENT
THE CONFLICT BETWEEN
HER KNOWLEDGE OF AN
ANXIETY – PROVOKING REALITY
AND HER EFFORT TO DENY IT,
THE THERAPIST IS DEFTLY
SIDESTEPPING THE POTENTIAL
FOR CONFLICT “BETWEEN”
PATIENT AND THERAPIST
43

CONFLICT STATEMENTS
IT IS, AFTER ALL, AN UNTENABLE
SITUATION FOR THE THERAPIST TO
PUT HERSELF IN THE POSITION OF
REPRESENTING THE HEALTHY
VOICE OF “YES” AND FOR THE
PATIENT, MADE ANXIOUS, TO BE
THEN STUCK IN THE POSITION OF
HAVING TO COUNTER WITH THE
UNHEALTHY VOICE OF “NO”
44

CONFLICT STATEMENT
“YOU KNOW THAT IF YOU REALLY ARE
SERIOUS ABOUT FINDING YOURSELF
A LIFE PARTNER, THEN YOU WILL NEED
TO TAKE SOME RISKS AND PUT
YOURSELF OUT THERE IN A WAY
THAT YOU DO NOT ORDINARILY DO;
BUT YOU FIND YOURSELF HOLDING BACK
FOR FEAR THAT, NO MATTER HOW
HARD YOU MIGHT TRY, IT WOULD NOT
REALLY MAKE ANY DIFFERENCE ANYWAY –
THE DESPAIR GOES SO DEEP.”
45

BY REPEATEDLY FORMULATING CONFLICT
STATEMENTS THAT STRATEGICALLY
JUXTAPOSE THE PATIENT’S DAWNING
AWARENESS OF JUST HOW STEEP A PRICE
SHE PAYS FOR HOLDING ON TO HER DEFENSES
(THE PAIN)
AND HER NEW – FOUND APPRECIATION FOR
HOW THEY HAVE SERVED HER EVEN SO
(THE GAIN),
THE THERAPIST WILL BE ABLE TO CREATE
GALVANIZING TENSION WITHIN THE PATIENT
COGNITIVE DISSONANCE THAT WILL
ULTIMATELY BECOME THE
FULCRUM FOR THERAPEUTIC CHANGE
46

AS LONG AS THE GAIN IS
GREATER THAN THE PAIN,
THE PATIENT WILL MAINTAIN THE DEFENSE
AND REMAIN ENTRENCHED 
BUT ONCE THE PAIN BECOMES
GREATER THAN THE GAIN
(THAT IS, ONCE THE DEFENSE BECOMES
MORE EGO – DYSTONIC THAN EGO – SYNTONIC),
THEN THE STRESS AND STRAIN THEREBY
CREATED AS A RESULT OF THE
COGNITIVE DISSONANCE BETWEEN PAIN AND GAIN
WILL PROVIDE THE IMPETUS NEEDED
FOR THE PATIENT
IN ORDER TO RESTORE HER PSYCHOLOGICAL EQUILIBRIUM
TO RELINQUISH THE UNHEALTHY DEFENSE
IN FAVOR OF A HEALTHIER ADAPTATION
47

THE WISDOM OF THE BODY
(CANNON 1932)
IT CANNOT TOLERATE
DISEQUILIBRIUM FOR
EXTENDED PERIODS OF TIME
AND WILL THEREFORE
BE PROMPTED TO TAKE
ACTION IN ORDER TO
RESOLVE THE TENSION
AND RESTORE THE ORDER
48

WHEREAS CONFLICT STATEMENTS ARE DESIGNED
TO COMPEL THE PATIENT TO LET GO
OF DEFENSES BY CREATING
INCENTIVIZING TENSION WITHIN HER,
DISILLUSIONMENT STATEMENTS
ARE DESIGNED TO FACILITATE
THE GRIEVING SHE MUST DO AS
SHE BEGINS TO CONFRONT
THE HEARTBREAKING REALITIES
AGAINST WHICH HER DEFENSES
HAVE BEEN PROTECTING HER
49

CONFLICT STATEMENTS AND
FIRST CHALLENGE
BY SPEAKING TO
PAINFUL TRUTHS
THAT THE PATIENT REALLY
DOES KNOW TO BE TRUE
AND THEN SUPPORT
ALWAYS WITH COMPASSION AND NEVER WITH JUDGMENT
BY RESONATING EMPATHICALLY
WITH HOW THE PATIENT
IS DEALING WITH
THOSE PAINFUL REALITIES
50

IF DEFENSIVELY
BECAUSE THE ANXIETY IS SIMPLY TOO MUCH
A CONFLICT STATEMENT
“YOU KNOW THAT …,
BUT (MADE ANXIOUS) YOU DEFEND”
IN ORDER TO AVOID FEELING THE PAIN
IF ADAPTIVELY
BECAUSE THE ANXIETY IS MORE MANAGEABLE
A DISILLUSIONMENT STATEMENT
“YOU KNOW THAT …,
AND (LESS ANXIOUS) YOU ADAPT”
AND LET YOURSELF FEEL THE PAIN OF YOUR GRIEF
51

“YOU ARE COMING TO UNDERSTAND THAT I
DO NOT HAVE ALL THE ANSWERS AND CANNOT
SIMPLY MAKE YOUR PAIN GO AWAY;
AND IT BREAKS YOUR HEART.”
“YOU HAD SO HOPED THAT ALEKSY WOULD
BE ‘THE ONE,’ BUT HIS ABUSIVE TREATMENT OF
YOU IS BECOMING INCREASINGLY INTOLERABLE.
YOU ARE BEGINNING TO REALIZE THAT
YOU WILL PROBABLY NEED TO LET HIM GO,
AND IT IS ABSOLUTELY DEVASTATING.”
52

COMPULSIVE REPETITIONS
AND RELENTLESS PURSUITS
IT IS THE PATIENT’S REFUSAL TO DEAL WITH
THE PAIN OF HER GRIEF ABOUT THE
PEOPLE WHO HAVE BROKEN HER HEART
THAT FUELS HER COMPULSIVE REPETITIONS
AND HER RELENTLESS PURSUITS
THE HOPE BEING THAT PERHAPS
THIS NEXT TIME IT WILL BE DIFFERENT
53

RELENTLESS HOPE AND
RELENTLESS OUTRAGE
MORE SPECIFICALLY
THE PATIENT’S REFUSAL TO GRIEVE FUELS BOTH
THE RELENTLESSNESS OF HER HOPE
THAT SHE MIGHT YET BE ABLE TO FORCE
THE OBJECT OF HER DESIRE TO CHANGE
AND THE RELENTLESSNESS OF THE OUTRAGE
SHE EXPERIENCES IN THOSE MOMENTS
OF DAWNING RECOGNITION THAT, DESPITE
HER BEST EFFORTS AND MOST FERVENT
DESIRE, SHE MIGHT NEVER BE ABLE TO
MAKE THAT ACTUALLY HAPPEN
54

I AM HERE REMINDED OF
THE NEW YORKER CARTOON
IN WHICH A GENTLEMAN,
SEATED IN A RESTAURANT NAMED
THE DISILLUSIONMENT CAFÉ,
IS AWAITING THE ARRIVAL
OF HIS ORDER
THE WAITER RETURNS TO HIS
TABLE AND ANNOUNCES,
“YOUR ORDER IS NOT READY,
AND NOR WILL IT EVER BE.”
55

BUT THE JUDICIOUS USE OF
CONFLICT STATEMENTS
THAT CHALLENGE THE PATIENT TO LET GO
AND DISILLUSIONMENT STATEMENTS
THAT SUPPORT HER AS SHE GRIEVES
WILL ENABLE THE PATIENT TO DO
NOW WHAT WAS TOO OVERWHELMING
FOR HER TO DO AT THE TIME OF THE
ORIGINAL TRAUMATIC INJURIES
AND ONGOING USE OF THESE OPTIMALLY
STRESSFUL INTERVENTIONS WILL GENERATE
HEALING CYCLES OF DISRUPTION
IN REACTION TO THE CHALLENGE
AND REPAIR
IN RESPONSE TO THE SUPPORT
56

WITHIN THE CONTEXT OF SAFETY
PROVIDED BY THE RELATIONSHIP
WITH HER THERAPIST,
THE PATIENT WILL BE GIVEN AN
OPPORTUNITY, AT LAST, TO CONFRONT
– AND GRIEVE –
THE PAIN OF HER EARLY – ON HEARTBREAK
PAIN AGAINST WHICH SHE HAS SPENT
A LIFETIME DEFENDING HERSELF
57

GENUINE GRIEVING
INVOLVES FEELING TO THE DEPTHS OF OUR
SOUL ALL THE RAGE, ANGUISH, HEARTBREAK,
SADNESS, AND REGRET THAT COME WITH
CONFRONTING EXCRUCIATINGLY PAINFUL REALITIES
ABOUT THE OBJECTS OF OUR DESIRE
BOTH PAST AND PRESENT
IT IS ULTIMATELY A STORY ABOUT
FORGIVING, RELENTING, LETTING GO,
SEPARATING, AND MOVING ON
SADDER PERHAPS BUT WISER TOO
IT IS ULTIMATELY A STORY ABOUT
SERENE ACCEPTANCE
OF SOBERING TRUTHS
58

IT IS WHAT IT IS – IT WAS WHAT IT WAS
AND, AT THE END OF THE DAY,
AS THE SERENITY PRAYER REMINDS US,
WE MUST ACCEPT THE THINGS
THAT WE CANNOT CHANGE,
MUST HAVE THE COURAGE TO
CHANGE THE THINGS THAT WE CAN,
AND MUST HAVE THE WISDOM
TO KNOW THE DIFFERENCE
(SIFTON 2005)
59

“GRIEF IS NATURE’S
WAY OF HEALING
A BROKEN HEART.”
(BECKMANN 1990)
60

AUTOBIOGRAPHY IN 5 SHORT CHAPTERS by Portia Nelson (2012)
CHAPTER 1
I WALK DOWN THE STREET
THERE IS A DEEP HOLE IN THE SIDEWALK
I FALL IN
I AM LOST … I AM HELPLESS
IT ISN’T MY FAULT
IT TAKES FOREVER TO FIND A WAY OUT
CHAPTER 2
I WALK DOWN THE SAME STREET
I PRETEND I DON’T SEE IT
I FALL IN AGAIN
I CAN’T BELIEVE I AM IN THE SAME PLACE
BUT IT ISN’T MY FAULT
IT STILL TAKES A LONG TIME TO GET OUT
61

CHAPTER 3
I SEE IT IS THERE
I STILL FALL IN … IT’S A HABIT
MY EYES ARE OPEN
I KNOW WHERE I AM
IT IS MY FAULT
I GET OUT IMMEDIATELY
CHAPTER 4
I WALK AROUND IT
CHAPTER 5
I WALK DOWN ANOTHER STREET
62

OPTIMAL STRESS
STRONGER AT THE BROKEN PLACES
IS THERE NOT A CERTAIN BEAUTY IN BROKENNESS,
A BEAUTY NEVER ACHIEVED BY THINGS UNBROKEN?
IF A BONE IS FRACTURED AND THEN HEALS,
THE AREA OF THE BREAK WILL BE STRONGER
THAN THE SURROUNDING BONE
AND WILL NOT AGAIN EASILY FRACTURE
ARE WE TOO NOT STRONGER AT OUR BROKEN PLACES?
AND IS THERE NOT A CERTAIN BEAUTY IN BROKENNESS,
A QUIET STRENGTH WE ACQUIRE
FROM SURVIVING ADVERSITY AND HARDSHIP
AND MASTERING THE EXPERIENCE OF
DISAPPOINTMENT, HEARTBREAK, AND DEVASTATION?
AND, THEN, WHEN WE FINALLY RISE ABOVE IT,
DON’T WE RISE UP IN QUIET TRIUMPH,
EVEN IF ONLY WE NOTICE … 65

REFERENCES
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support groups. Learning Publishing.
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major depression. Arch Intern Med 1999;159(19):2349-2356.
Cannon, W. B. 1932. The wisdom of the body. New York: W. W. Norton & Co.
Frankl, V. 2006. Man’s search for meaning. Boston, MA; Beacon Press.
Kauffman, S. 1995. At home in the universe: The search for the laws of
self-organization and complexity. New York: Oxford University.
Krebs, C. 1998. A revolutionary way of thinking: From a near fatal accident
to a new science of healing. Melbourne, Australia: Hill of Content.
Leibenluft, E., and T. A. Wehr. Is sleep deprivation useful in the treatment
of depression? Am J Psychiatry 1992;149(2):159-168.
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Nelson, P. 2012. There’s a hole in my sidewalk: The romance of
self-discovery. New York: Atria Books.
Paracelsus, T. 2004. The archidoxes of magic. Turner R (trans).
Temecula, CA: Ibis Publishing.
Selye, H. 1974. Stress without distress. New York: Harper & Row.
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Stark, M. 1999. Modes of therapeutic action: Enhancement of
knowledge, provision of experience, and engagement in relationship.
Northvale, NJ: Jason Aronson.
Stark, M. Hormesis, adaptation, and the sandpile model. Crit Rev
Toxicol 2008;38(7):641-644.
Stark, M. The sandpile model: Optimal stress and hormesis. Dose
Response 2012;10(1):66-74.
67

REFERENCES
Stark, M. 2014. Optimal stress, psychological resilience, and the sandpile
model. In Hormesis in health and disease, ed. S. Rattan, and E.
Le Bourg, 201-224. Boca Raton, FL: CRC Press / Taylor & Francis.
Stark, M. 2015. Integrative psychotherapy: Healing the MindBodyMatrix.
In Integrative therapies for depression: Redefining models for
assessment, treatment, and prevention, ed. J. Greenblatt, and
K. Brogan. Boca Raton, FL: CRC Press / Taylor & Francis.
Strogatz, S. 1994. Nonlinear dynamics and chaos: With applications to
physics, biology, chemistry, and engineering. Cambridge, MA:
Perseus Books.
Zevon, W. 1996. I’ll sleep when I’m dead. Burbank, CA: Elektra Records.
68

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